Why dad's diabetes causes pain in his feet

Q: My dad is 65 years old and has Type 2 diabetes. He recently developed pain in his feet, which his doctor says is peripheral neuropathy. What is that, and what treatments are available?

A: Neuropathy is a condition in which the nervous system malfunctions due to either disease or some kind of damage. The addition of the word "peripheral" means the problem lies in the vast and complex network of nerves that serves the body.

The peripheral nervous system collects and sends vital sensory information to the central nervous system, which is made up of the brain and the spinal cord. When you drop that hot frying pan handle, break into a sweat on a hot day or keep your balance with your eyes closed, that's all thanks to information your peripheral nervous system has sent to your brain.

It's estimated that 20 million people in the United States experience some kind of peripheral neuropathy. Sometimes the damage is limited to a single nerve, but most often the condition affects groups of nerves. Symptoms include numbness, twitching, throbbing or tingling, burning sensations, problems with balance, or skin sensitivity so acute that ordinary stimuli, like the touch of a shirt on bare skin, are interpreted as pain.

When the motor nerves are affected, peripheral neuropathy causes muscle weakness and can often lead to the loss of muscle mass. If the nerves that serve the organs or glands are involved, it can result in impaired digestion, perspiration, urination or sexual function. At its most extreme, peripheral neuropathy causes breathing difficulties, or leads to organ failure. Fortunately, this is rare.

Diabetes is the most common cause of peripheral neuropathy. Other factors include infections such as shingles or the Epstein-Barr virus, certain kidney disorders, vitamin deficiencies, physical damage, cancers that press on or infiltrate nerve fibers, or autoimmune diseases that cause the body to attack its own tissues. Exposure to toxic industrial and environmental substances such as lead, arsenic or pesticides as well as medical agents like chemotherapy drugs can also lead to the condition. So can heavy alcohol consumption.

Your father's symptoms began in his feet, which is common among people with diabetes. He may also experience numbness, a decrease in foot and ankle reflexes, trouble with balance and coordination, and an increase in foot problems like ulcers and infections. This is due to tissue damage resulting from chronic high blood glucose levels, as well as decreased circulation, which occurs because diabetes causes the blood vessels in the foot and leg to become stiff and grow narrow.

Treatment for your father's condition will focus on two things: carefully controlling his diabetes to prevent further nerve damage, and giving him relief from the existing pain.

Mild pain often responds to over-the-counter pain relievers. Medications like antidepressants, anticonvulsants and narcotics are used for chronic pain. Procedures like electrical nerve stimulation have shown promise. Physical therapy and specialized footwear can also help.

Pain treatment is often most effective when there's an ongoing dialogue. Be sure your dad shares all his symptoms with his doctor, and follows up with regular progress reports.

Q: Our family - ages 66, 59, 27 and 22 - lives in one household. We've been working from home and keeping socially distant since the start of the pandemic. Now the younger members wish to resume outside employment. How do we safely manage their return to work?

A: The challenge in multigenerational households like yours is keeping the older members safe. The answer lies in the basic precautions we've learned to take during this pandemic, along with an added layer of vigilance and awareness. We may sound like a broken record by now, but that means wear a mask, maintain distance from people outside of your household and be consistent about washing your hands.

We tell our patients to assume each time they leave their homes, they will encounter someone infected with the coronavirus, and to behave accordingly. Considering the spiking infections across the nation at this time, that's not an exaggeration.

When it comes to the younger people spending time outside the family bubble, you're talking about an increased level of risk. Any risks they take outside of the home, they bring home with them. While in the workplace, they need to wear a good mask at all times, and continue social distancing as much as possible. The fabric of a mask not only limits the distance someone's breath will travel, it also provides a physical barrier that can protect the wearer as well. That's important because we now know that some transmission of the coronavirus is airborne. We also know that some individuals can be infected with the virus but have either no symptoms or symptoms that are quite mild. They're lucky enough not to feel sick, but, unfortunately, they are still able to pass the virus along to other people, who may become quite ill.

Physical distancing remains important. Studies have made a connection between viral load, which is the concentration of virus someone is exposed to, and the severity of subsequent infection. The further away you stand from someone, the less their exhaled breath can reach you. When combined with a mask, social distancing can measurably reduce your risk of coming into contact with the virus. And, because viral particles can also be carried via droplets that land and persist on surfaces, washing or sanitizing your hands, as well as high-touch surfaces, remains important.

Your family should discuss their comfort with risk, then decide the steps to take to address it. This can include no physical contact, sequestering in different parts of the home and even wearing masks in each other's presence. Ventilation is important, so if your climate allows, keep windows and doors open, and spend time together outdoors. Remain alert for COVID-19 symptoms, which include fever, chills, exhaustion, difficulty breathing, headache, gastric upset and sudden loss of taste or smell. If someone begins to feel unwell, or has contact with an infected source, they should isolate from the rest of the family immediately to prevent spread. If you follow these measures and don't let your guard down, the risk of infection and transmission will remain low.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.